Medicare

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 FY 2019 Medicare SNF PPS Rate Calculator Tool

DISCLAIMER:  This FY 2019 Medicare SNF PPS Rate Calculator is not an official CMS calculator.  This calculator, with your facility-specific inputs, provides estimated SNF PPS rates and revenues based on tables from the final rule.  We anticipate some technical correction updates from CMS, and possible minor calculation or rounding errors for some situations, but overall this tool should provide a close estimate on the revenue impact of all the payment adjustments that go into effect in FY 2019.  This tool includes the 2.4% market basket rate increase, the SNF QRP adjustment (for affected facilities), the SNF VBP incentive payment multiplier, and sequester adjustment.


​Medicare Part B Fee Schedules

 
DISCLAIMER:  These files are not official CMS files, although every effort was made to assure their accuracy for your needs.  If in doubt, always refer to your Medicare contractor and/or the CMS website. 

​News & Resources

 Accountable Care Organizations

​ACO Toolkit - Members Only

  • Module 1 – Overview of the ACO Program: This module provides an overview of the structure, financial model and regulatory requirements of ACOS as well an understanding of how ACOs work including who can participate, beneficiary attribution, financial incentives, quality reporting and waivers.
  • Module 2 – Role of PAC and SNFs within ACOs: Building on Module 1, Module 2 provides a more detailed understanding of the role and opportunity for SNF/PAC into the ACO model.
  • Module 3 – ACO-SNF Contracting Guide: Module 3 highlights the key components in the development and negotiation of contracts between SNFs and ACOs including the key components of a contract, recommendations on terms that should (or should not) be in the contract, and important considerations for contract negotiation.

ACO Webinar: March 19th at 2pm EST

  • Pre-requisite: Reviewing the modules and pre-recorded webinars
  • Question and Answer webinar to clarify information in the modules or on the webinars and/or make recommendations or suggestions.


​Medicare Managed Care

 
Managing Medicare Managed Care pulls together relevant existing AHCA/NCAL managed care resources and a new Contract Assessment and Return on Investment tool to assist in evaluating the value of your current managed care contracts.

Medicare Advantage (MA) is the managed care program within Medicare. Medicare Advantage provides beneficiaries with the option to receive their Medicare benefits through private health plans. MA continues to grow rapidly and has doubled over the past decade to over 26 million people in 2021, which is 42% of all Medicare beneficiaries (see below). This growth is expected to continue as more and more individuals age 65+ are opting to have their care be managed by a private health plan and are attracted by the additional benefits that are offered through an MA plan. HMOs continue to account for the majority (62%) of all plans offered in 2021.